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In this chapter, a conversation-analytic approach is used to study medical recom­mendations as an essential part of medical advice. Tlte analyses are based on renal treatment planning conversations in which physicians inform patients about an upcoming dialysis thera­py. The data reveals that medical recommendations are marked throughout by their strikingly tentative and relativistic phrasing in which the conflict between physicians duty of care and the patient’s autonomy is obvious. The observed discrepancy between what should be said and what patients and physicians want to be said - and heard - not only gives reason to challenge the ethical and legal requirements concerning medical recommendations and their implications for medical practice, but also to rethink the current models of decision-making in medical communication.

Based on German data from history-taking in doctor-patient interaction, the paper shows that the three basic syntactic types of questions (questions fronted by a question-word (w-questions), verb-first (V1) questions, and declarative questions) provide different opportunities for displaying understanding in medical interaction. Each syntactic questionformat is predominantly used in a different stage of topical sequences in history taking: w-questions presuppose less knowledge and are thus used to open up topical sequences; declarative questions are used to check already achieved understandings and to close topical sequences. Still, the expected scope of answers to yes/no-questions and to declarative questions is less restricted than previously thought. The paper focuses in detail on the doctors’ use of formulations as declarative questions, which are designed to make patients elaborate on already established topics, giving more details or accounting for a confirmation. Formulations often involve a shift to psychological aspects of the illness. Although patients confirm doctors’ empathetic formulations, they, however, regularly do not align with this shift, returning to the description of symptoms and to biomedical accounts instead. The study shows how displays of understanding are responded to not only in terms of correctness, but also (and more importantly) in terms of their relevance for further action.